위암 1,000. EndoTODAY 이준행

[Gastric cancer 654 - Biopsy for Borrmann type IV]

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Histologic examination of poorly differentiated adenocarcinoma may be tricky. A patient was referred for biopsy for suspected Borrmann type 4 AGC. Endoscopy with biopsy was done and the pathology was poorly differentiated adenocarcinoma and surgery was done. To my surprise, outside pathology review was also poorly differentiated adenocarcinoma.

The first two biopsies were negative for malignancy. The third biopsy showed P/D adenocarcinoma.
Stomach, subtotal gastrectomy: Advanced gastric carcinoma
1. Location : [1] middle third, [2] lower third Center at body and lesser curvature
2. Gross type : Borrmann type 4
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 6x5 cm
6. Depth of invasion : invades serosa (pT4a)
7. Resection margin: free from carcinoma, safety margin: proximal 5 cm, distal 2.7 cm
8. Lymph node metastasis : metastasis to 1 out of 48 regional lymph nodes (pN1) (perinodal extension: absent) (1/48: "3", 0/12; "4", 0/2; "5", 0/1; "6", 0/3; "7", 0/10; "9", 0/2; "8a", 0/8; "11p", 0/0; "12a", 0/0; "4sb", 0/0; "1", 0/3; "2", 0/1; "mesentery LN", 0/2; perigastric, 1/4)
9. Lymphatic invasion : present
10. Venous invasion : present(extramural)
11. Perineural invasion : present (+++)
12. Peritoneal cytology : negative
13. AJCC stage by 8th edition: pT4a N1

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